9.2 The Baby Friendly Initiative
Innocenti Declaration
Some 10 years after the WHO Code was first signed a group of high-level policy-makers convened; the outcome was the release of the Innocenti Declaration. The Innocenti Declaration was endorsed by the World Health Assembly in 1991, giving it world-wide status and acceptance. It is the most concise international statement on breastfeeding and covers all three facets of protection, promotion and support.
The Innocenti Declaration set 4 targets for all governments:
- To appoint a national breastfeeding coordinator and a multi-sectoral national breastfeeding promotion committee. This target put accountability directly in the hands of each nations' government.
- That governments would have taken action to implement the International Code of Marketing of Breastmilk Substitutes.
- That maternity facilities should practice the recently published Ten Steps to Successful Breastfeeding. This came at just the right time historically. The launching of the Baby Friendly Hospital Initiative has been the most important and powerful step ever taken on behalf of breastfeeding. It has put breastfeeding on the health policy map in almost every country in the world.
- To enact imaginative legislation to protect the breastfeeding rights of working women.
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![]() | ![]() Reaching the targetsIn 2005, 15 years after setting the original goals, a celebration was held to evaluate progress and re-affirm commitment to the targets.
The targets were ambitious and although they were not fully achieved by the projected date, great progress was made:
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The Baby Friendly Initiative
You may be working in an accredited Baby Friendly facility already or your hospital/institution may be working towards that now.
The thought process began more than 20 years ago to set targets and implement steps to increase world breastfeeding trends.
The thought process began more than 20 years ago to set targets and implement steps to increase world breastfeeding trends.
Baby Friendly hospitals
The Baby Friendly Hospital Initiative (BFHI) was launched by WHO and UNICEF in June 1991 at a meeting of the International Pediatric Association. The goal is to promote the adoption of the Ten Steps to Successful Breastfeeding in hospitals worldwide by the designation of a Baby-Friendly Hospital Initiative award. It is designed to remove hospital barriers to breastfeeding by creating a supportive environment with trained and knowledgeable health workers.

A proud hospital!
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![]() | ![]() Ten Steps to Successful BreastfeedingEvery facility providing maternity services and care for newborn infants should:
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Baby Friendly communities
To continue the best practices initiated in the hospital situation, and to provide supportive care to the mother, UNICEF/BFI United Kingdom developed best practice standards for the community. The Seven-point Plan for the Protection, Promotion and Support of Breastfeeding in Community Health Services follows the same principles as the Ten Steps to Successful Breastfeeding. The emphasis is to ensure consistency of advice for mothers and continuity of care when care is passed from maternity to community services.
Community facilities who acquire the Seven-Point Plan Award are often referred to a "mother-child friendly" or "breastfeeding-friendly".
Community facilities who acquire the Seven-Point Plan Award are often referred to a "mother-child friendly" or "breastfeeding-friendly".
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![]() | ![]() Seven-Point PlanThe 7 points in summary are:
1. Have a written breastfeeding policy that is routinely communicated to all health-care staff. 2. Train all staff involved in the care of mothers and babies in the skills necessary to implement the policy. 3. Inform all pregnant women about the benefits and management of breastfeeding. 4. Support mothers to initiate and maintain breastfeeding. 5. Encourage exclusive and continued breastfeeding, with appropriately-timed introduction of complementary foods. 6. Provide a welcoming atmosphere for breastfeeding families. 7. Promote cooperation between health-care staff, breastfeeding support groups and the local community. Source: 2001 UNICEF/BFI UK | ![]() |
Does Baby Friendly Work?
- UNICEF, in 1999, reported widespread increases in rates of breastfeeding in urban areas, reductions in respiratory infections and diarrhea in infants, and savings in terms of both costs and staff time when BFHI is implemented.
- USA - Baby-Friendly designated hospitals have elevated rates of breastfeeding initiation and exclusivity. Elevated rates persist regardless of demographic factors that are traditionally linked with low breastfeeding rates. 1
- China - after 2 years of implementation of the Ten Steps, exclusive breastfeeding rates doubled in rural areas and improved from 10% to 47% in urban areas.
- Cuba - exclusive breastfeeding rates increased from 25% in 1990 to 72% in 1996. 2
- Scotland - babies born in a Baby-Friendly accredited hospital were 28% more likely to be exclusively breastfed at 7 days of postnatal age than those born in other maternity units. 3
- UK - in a 2 year period of mandatory BFI training of health visitors and nursery nurses resulted in a 1.57 times increased likelihood of an infant being breastfed at 8 weeks. 4
Becoming accredited
To receive the Baby Friendly designation a hospital or community health unit will have fully embraced all of the Steps or Points, as well as adhere to the International Code on the Marketing of Breastmilk Substitutes. Achievement of the criteria will be assessed by a team of trained assessors who will make observations, view charts and feeding records and speak with mothers and the unit's staff.
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![]() | ![]() Workbook Activity 9.4Complete Activity 9.4 in your workbook. | ![]() |
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![]() | ![]() Poster PromotionGather a small working group to collect appropriate photos (or obtain permission from mothers to photograph them and their babies) which could be made into a poster for each of the Ten Steps or each of the Seven Points.
Display the posters in strategic areas in your workplace. | ![]() |
What should I remember?
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Self-test quiz
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Notes
- # Merewood A et al. (2005) Breastfeeding Rates in US Baby-Friendly Hospitals: Results of a National Survey
- # Philipp BL et al. (2004) The Baby-Friendly way: the best breastfeeding start.
- # Broadfoot M (2005) The Baby Friendly Hospital Initiative and breast feeding rates in Scotland
- # Ingram J et al. (2011) The effects of baby-friendly iniatiative training on breastfeeding rates and the breastfeeding attitudes, knowledge and self-efficacy of community health care staff.